Herman M I, Chyka P A, Butler A Y, Rieger S E
Southern Poison Center, LeBonheur Children's Medical Center, and The University of Tennessee, Memphis 38163, USA.
Ann Emerg Med. 1999 Jan;33(1):111-3. doi: 10.1016/s0196-0644(99)70427-0.
Intraosseous administration of methylene blue may be an emergency alternative to intravascular administration. A 6-week-old female infant (3 kg) presented to the emergency department after a 1-week illness and appeared cyanotic and listless. Oxygen saturation by oximetry was 86% while the patient was receiving oxygen. Vital signs were blood pressure, 107/80 mm Hg; pulse, 190; respirations, 47; temperature, 39.0 degreesC. A metabolic acidosis and a methemoglobin level of 29.3% were present. After several unsuccessful attempts to establish intravenous access, an intraosseous needle was placed in the infant's left tibia. Methylene blue, 1 mg/kg, normal saline solution, and sodium bicarbonate were given intraosseously. The patient's oxygen saturation rose to 98% to 100%, and her cyanosis improved. Three hours later, her methemoglobin level was 8.2%. The child recovered uneventfully and was sent home after 3 days. Intraosseous administration of standard intravenous doses of methylene blue rapidly terminated the effects of acquired methemoglobinemia.
骨髓腔内注射亚甲蓝可能是血管内注射的一种紧急替代方法。一名6周大的女婴（3千克）在患病1周后被送往急诊科，她面色青紫、精神萎靡。在吸氧状态下，经皮血氧饱和度为86%。生命体征为：血压107/80毫米汞柱；脉搏190次/分；呼吸47次/分；体温39.0摄氏度。存在代谢性酸中毒，高铁血红蛋白水平为29.3%。在多次尝试建立静脉通路失败后，在婴儿的左胫骨处置入了一根骨髓腔内穿刺针。通过骨髓腔内注射了1毫克/千克的亚甲蓝、生理盐水和碳酸氢钠。患儿的血氧饱和度升至98%至100%，青紫症状有所改善。3小时后，她的高铁血红蛋白水平为8.2%。患儿顺利康复，3天后出院。按照标准静脉剂量经骨髓腔内注射亚甲蓝可迅速消除获得性高铁血红蛋白血症的影响。
